Bendopnea as a Symptom of Advanced Heart Failure

Bendopnea, first described back in 2014, is shortness of breath while bending over. It is now recognized as a symptom of heart failure.

Shortness of breath, or dyspnea, is a well-known symptom in people who have heart failure. Dyspnea can take several forms. Dyspnea with exertion is the most common form and dyspnea that occurs when lying down (orthopnea) is another frequent symptom.

Because of their orthopnea, people with heart failure often need to use several pillows to sleep comfortably or may even have to sleep sitting up. Paroxysmal nocturnal dyspnea (PND) is a particularly dramatic form of dyspnea that can wake a person with heart failure out of a deep sleep.

Dyspnea on exertion, orthopnea, and PND are each considered to be classic symptoms of heart failure. Each of these manifestations of dyspnea caused by heart failure has been well recognized by many generations of physicians.

In 2014, researchers from the University of Texas described yet another kind of dyspnea seen in people with heart failure—shortness of breath that occurs while bending over. To describe this new symptom, they coined the word bendopnea—“pnea” from the Greek pnoia for breath and "bendo” from the Texan for bend over.

The researchers noticed that some of their patients with heart failure complained of dyspnea when bending over, so they conducted a study both to assess the frequency of this symptom and to determine its medical significance.

They studied 102 patients with heart failure due to dilated cardiomyopathy. Each person was asked to sit in a chair and bend over for 30 seconds, as if they were tying a shoe. Twenty-nine patients (28 percent) experienced bendopnea.

The more “classic” symptoms of heart failure (such as dyspnea on exertion and orthopnea) tended to be more severe in the people who had bendopnea during the 30-second test. Further, bendopnea was more commonly experienced by those who also had significant fluid retention and edema (swelling in the legs).

The researchers also performed a heart catheterization on all 102 patients in the study. They found that the 29 people with bendopnea, on average, had significantly more advanced forms of heart failure than those without bendopnea—specifically, the pressures inside their hearts were more elevated. All of these findings indicated that the symptom of bendopnea seemed to be associated with heart failure that is more advanced or poorly controlled.

People with heart failure usually have elevated cardiac pressures. This high cardiac pressure tends to cause a backup of the blood returning to the heart from the lungs, which can lead to pulmonary congestion, and thus to dyspnea.

Anything that causes a further increase in cardiac pressures can make this problem worse. Physical exertion does this, and dyspnea on exertion is a common symptom in people with heart failure. Lying flat causes body fluids to redistribute to the chest, which also increases cardiac pressures, leading to orthopnea.

To a somewhat lesser extent, bending over at the waist also increases pressures within the chest (and thus, within the heart). For people whose heart failure is barely compensated, the relatively small increase in cardiac pressure caused by bending over may tip them over the edge and produce dyspnea.

While this was a small study, it strongly indicates that the appearance of bendopnea in a person with heart failure may be taken as a likely sign that their condition is worsening. The test for bendopnea is quick and simple to perform (that is, sit down and bend over for 30 seconds) and many doctors may end up adding it to their routine evaluation of patients with heart failure.

Whether the symptom of bendopnea may also be helpful in diagnosing previously unknown heart failure is unknown since this symptom has not been studied as a screening tool. However, since bendopnea seems to correlate with more advanced heart failure, it seems likely that in most instances the diagnosis of heart failure would be evident from other symptoms and signs before bendopnea ever appears.

Finally, it is worth noting that feeling short of breath while bending over may be caused by many conditions other than heart failure, including various lung disorders or simply being overweight. So, if you notice the symptom of bendopnea, it does not necessarily mean that you have heart failure. But, it does mean you should check with your doctor about this symptom.